Structural connections between the noradrenergic and cholinergic system shape the dynamics of functional brain networks.

Complex cognitive abilities are thought to arise from the ability of the brain to adaptively reconfigure its internal network structure as a function of task demands. Recent work has suggested that this inherent flexibility may in part be conferred by the widespread projections of the ascending arousal systems. While the different components of the ascending arousal system are often studied in isolation, there are anatomical connections between neuromodulatory hubs that we hypothesise are crucial for mediating key features of adaptive network dynamics, such as the balance between integration and segregation. To test this hypothesis, we estimated the strength of structural connectivity between key hubs of the noradrenergic and cholinergic arousal systems (the locus coeruleus [LC] and nucleus basalis of Meynert [nbM], respectively). We then asked whether the strength of structural LC and nbM inter-connectivity was related to individual differences in the emergent, dynamical signatures of functional integration measured from resting state fMRI data, such as network and attractor topography. We observed a significant positive relationship between the strength of white-matter connections between the LC and nbM and the extent of network-level integration following BOLD signal peaks in LC relative to nbM activity. In addition, individuals with denser white-matter streamlines interconnecting neuromodulatory hubs also demonstrated a heightened ability to shift to novel brain states. These results suggest that individuals with stronger structural connectivity between the noradrenergic and cholinergic systems have a greater capacity to mediate the flexible network dynamics required to support complex, adaptive behaviour. Furthermore, our results highlight the underlying static features of the neuromodulatory hubs can impose some constraints on the dynamic features of the brain.

Generation of an equine biobank to be used for Functional Annotation of Animal Genomes project.

The Functional Annotation of Animal Genomes (FAANG) project aims to identify genomic regulatory elements in both sexes across multiple stages of development in domesticated animals. This study represents the first stage of the FAANG project for the horse, Equus caballus. A biobank of 80 tissue samples, two cell lines and six body fluids was created from two adult Thoroughbred mares. Ante-mortem assessments included full physical examinations, lameness, ophthalmologic and neurologic evaluations. Complete blood counts and serum biochemistries were also performed. At necropsy, in addition to tissue samples, aliquots of serum, ethylenediaminetetraacetic acid (EDTA) plasma, heparinized plasma, cerebrospinal fluid, synovial fluid, urine and microbiome samples from all regions of the gastrointestinal and urogenital tracts were collected. Epidermal keratinocytes and dermal fibroblasts were cultured from skin samples. All tissues were grossly and histologically evaluated by a board-certified veterinary pathologist. The results of the clinical and pathological evaluations identified subclinical eosinophilic and lymphocytic infiltration throughout the length of the gastrointestinal tract as well as a mild clinical lameness in both animals. Each sample was cryo-preserved in multiple ways, and nuclei were extracted from selected tissues. These samples represent the first published systemically healthy equine-specific biobank with extensive clinical phenotyping ante- and post-mortem. The tissues in the biobank are intended for community-wide use in the functional annotation of the equine genome. The use of the biobank will improve the quality of the reference annotation and allow all equine researchers to elucidate unknown genomic and epigenomic causes of disease.

Unified neural field theory of brain dynamics underlying oscillations in Parkinson's disease and generalized epilepsies.

The mechanisms underlying pathologically synchronized neural oscillations in Parkinson's disease (PD) and generalized epilepsies are explored in parallel via a physiologically-based neural field model of the corticothalamic-basal ganglia (CTBG) system. The basal ganglia (BG) are approximated as a single effective population and their roles in the modulation of oscillatory dynamics of the corticothalamic (CT) system and vice versa are analyzed. In addition to normal EEG rhythms, enhanced activity around 4 Hz and 20 Hz exists in the model, consistent with the characteristic frequencies observed in PD. These rhythms result from resonances in loops formed between the BG and CT populations, analogous to those that underlie epileptic oscillations in a previous CT model, and which are still present in the combined CTBG system. Dopamine depletion is argued to weaken the dampening of these loop resonances in PD, and network connections then explain the significant coherence observed between BG, thalamic, and cortical population activity around 4-8 Hz and 20 Hz. Parallels between the afferent and efferent connection sites of the thalamic reticular nucleus (TRN) and BG predict low dopamine to correspond to a reduced likelihood of tonic-clonic (grand mal) seizures, which agrees with experimental findings. Furthermore, the model predicts an increased likelihood of absence (petit mal) seizure resulting from pathologically low dopamine levels in accordance with experimental observations. Suppression of absence seizure activity is demonstrated when afferent and efferent BG connections to the CT system are strengthened, which is consistent with other CTBG modeling studies. The BG are demonstrated to have a suppressive effect on activity of the CTBG system near tonic-clonic seizure states, which provides insight into the reported efficacy of current treatments in BG circuits. Sleep states of the TRN are also found to suppress pathological PD activity in accordance with observations. Overall, the findings demonstrate strong parallels between coherent oscillations in generalized epilepsies and PD, and provide insights into possible comorbidities.

[Defect coverage with myofasciocutaneous free flaps. Consequence of corticosteroid infiltration of the wrist in a patient on immunosuppressive therapy]. / Defektdeckung mit myofasziokutanem Lappen. Folge einer Kortikoidinfiltration des Handgelenks bei einer immunsuppressiv behandelten Patientin.

Intra-articular corticosteroid injection and radiation of the wrist was performed in a patient on immunosuppressive therapy. She sustained empyema and impending compartment syndrome. After fasciotomy, debridement and antibiotic therapy had been performed, we provided soft tissue coverage by a combined ALTP and muscular free flap on the vascular trunk of the descending branch of the lateral circumflex femoral artery. There were no complications and the patient is very satisfied with the outcome.

[Semilunar bone necrosis (Kienböck's disease) - first clinical results after free microvascularised bone graft from the distal femur]. / Die idiopathische Mondbeinnekrose (M. Kienböck) - Erste Ergebnisse nach operativer Therapie mit einem freien mikrovaskulären Femurtransplantat.

BACKGROUND: Idiopathic aseptic osseous necrosis of the semilunar bone is also called Kienböck's disease after Robert Kienböck who firstly described this disease. The clinical picture is characterised by a stage-like course. Internationally the classification according to Lichtman and Ross has achieved the most acceptance. The actual therapy is dependent on the present disease stage. Basically, various pressure-relieving operative procedures are possible, on the other hand operative interventions via revascularisation represent a therapeutic option. In the case of advanced disease only, "salvage procedures" like partial or total arthrodesis of the wrist are available. However, such operations are associated with marked restrictions in the range of motion and unsatisfactory clinical results. The present study reports on our clinical experiences after operative therapy for aseptic lunar bone necrosis via free microvascularised bone grafting from the distal femur. PATIENTS AND METHODS: Between 01/2005 and 12/2010 nineteen patients with idiopathic semilunar bone necrosis underwent operative care via a free microvascularised bone graft from the distal femur at our institution. 16 patients could be re-evaluated retrospectively on follow-up examination at 26.5 months (range 16-42) on average after primary care. Mean age was 43.8 years (range 24-66). Clinical assessment was performed according to the Mayo wrist score (MWS) and the disabilities of the arm, shoulder and hand (DASH) score. Radiological assessment was performed according to the classification of Lichtman and Ross. RESULTS: On operative treatment 14 patients were graded II at least according to the Lichtman classification. An additional 2 patients showed a stage III B disease. The median operative time amounted to 254 min (range 233-362). The postoperative course did not reveal any complications, in particular concerning wound healing. Only one patient (6 %) showed no trabecular integration between the inserted graft and the lunar bone. Clinical evaluation according to the MWS with a median of 82.5 points (65-100), and the DASH score with a median of 29.5 points (24.2-102.2) documented good to excellent clinical results. CONCLUSION: Operative treatment for idiopathic semilunar bone necrosis via a free microvascularised bone graft from distal femur achieves good clinical results without an increase of postoperative complications even with advanced stages of the disease. However, long-term results and larger patient samples are required to prove the final success of this operative technique.

GABA system changes in methylphenidate sensitized female rats.

Methylphenidate (MPD) is a psychostimulant that is prescribed to treat attention-deficit/hyperactivity disorder (ADHD) and has been used as a recreational drug. In animal models, repetitive exposure to methylphenidate can induce a behavioral sensitization. Stimulants are able to change neuronal circuits in the mesolimbic pathway, and the GABA system is one of the most involved neurotransmitter systems in this process. Women represent a risk group for psychostimulant abuse because they respond more strongly, which is probably due to the influence of sex hormones. The objective of the present study was to investigate the influence of sex hormones on behavioral sentsitization and changes to glutamic acid decarboxylase (GDA65 and GDA67) isoenzymes and α2 GABAA receptor subunit mRNA expression in the prefrontal cortex and the striatum of rats, as induced by methylphenidate administration (2.5 mg/kg, i.p.). Female rats were divided into 2 hormonal conditions: ovariectomized and intact group. Repeated methylphenidate treatment led to behavioral sensitization, which was stronger in females with circulating hormones (intact group). The analysis of mRNA levels in the striatum, in both groups, showed a decline in GAD65, but not GAD67, transcription after repeated methylphenidate treatment. In the prefrontal cortex, both GAD65 and GAD67 showed an increase in transcription with repeated methylphenidate treatment. There was no change in the transcription level of α2 GABAA receptor subunits. In conclusion, it was shown that sex hormones were able to modify behavioral sensitization to methylphenidate and the drug affected the GABA system in brain areas known to be involved in the development of drug dependence.

[Reconstruction of the elbow with the deep circumflex iliac artery. Multicomponent free flap plasty after a gunshot wound]. / Rekonstruktion des Ellenbogens durch eine A. circumflexa iliaca profunda. Mehrkomponentenlappenplastik nach einer Schussverletzung.

A 20-year-old woman sustained massive elbow trauma from a gunshot wound. After initial surgery soft tissue coverage, reconstruction of the proximal third of the ulna, of the ulnar collateral ligament and of the triceps tendon was performed by one multicomponent microvascular free flap. There were no complications, the elbow is stable and reached full weight bearing 11 months after trauma. Active range of motion for extension and flexion is 0-20°-80°.

Akt promotes chemoresistance in human ovarian cancer cells by modulating cisplatin-induced, p53-dependent ubiquitination of FLICE-like inhibitory protein.

Although Akt is a determinant of cisplatin (cis-diaminedichloroplatinum (CDDP)) resistance in ovarian cancer cells, which is related in part to its inhibitory action on p53 activation, precisely how Akt confers CDDP resistance is unclear. In this study, we show that CDDP induced p53-dependent Fas-associated death domain-like interleukin-1beta-converting enzyme (FLICE)-like inhibitory protein (FLIP) degradation in chemosensitive ovarian cancer cells but not their resistant counterparts. CDDP induced FLIP-p53-Itch interaction, colocalization and FLIP ubiquitination in chemosensitive but not chemoresistant ovarian cancer cells. Moreover, although activated Akt inhibited CDDP-induced FLIP degradation and apoptosis in sensitive cells, these responses were facilitated by dominant-negative Akt expression in chemoresistant cells. Inhibition of Akt function also facilitated p53-FLIP interaction and FLIP ubiquitination, which were attenuated by p53 silencing. These results suggest that Akt confers resistance, in part, by modulating CDDP-induced, p53-dependent FLIP ubiquitination. Understanding the precise etiology of chemoresistance may improve treatment for ovarian cancer.

[Transarticular C1-C2 screw fixation: results of unstable odontoid fractures and pseudarthrosis in the elderly]. / Die transartikuläre C1-C2-Verschraubung: Ergebnisse bei instabilen Frakturen und Pseudarthrosen des Dens axis im Alter.

BACKGROUND: Transarticular dorsal screw fixation of atlantoaxial instability in the elderly is seldom described in the literature. This study presents the results of this technique in patients aged at least 70 years. A modified method of indirect screw fixation is used in which soft tissue dissection is reduced compared to the classic procedure. PATIENTS AND METHODS: Between 1998 and 2005 a total of 36 patients with acute or chronic traumatic instability of the atlantoaxial complex were treated surgically. The average age was 80.1 years (70-93 years). Seven patients (19.4%) had associated injuries. The operative technique was standard. The duration of radiological follow-up averaged 23 months (12-57 months) whereas clinical follow-up was for 38 months (12-72 months). RESULTS: There were no intraoperative complications. Of the total 72 screws inserted, 2 (2.8%) proved to be incorrectly positioned. There were complications not associated with the procedure in 16 patients (44.4%). Nosocomial infections and falls were the most common complications. Two deaths occurred within the first postoperative month. Four more patients died in the follow-up period as a result of diseases not associated with the trauma. Of the 30 surviving patients, 28 (93.3%) were followed up clinically and radiologically. Bony dorsal fusion was documented in every patient followed up. Further operation on the cervical spine was not required in any patient. CONCLUSION: The presented technique of transarticular C1-C2 screw fixation is associated with reliable fusion rates and good functional results. The procedure can be recommended for atlantoaxial instability in the elderly.

[A new vascularized cartilague-bone-graft for scaphoid nonunion with avascular necrosis of the proximal pole. Description of a new type of surgical procedure]. / Freies gefässgestieltes Knorpel-Knochen-Transplantat bei avaskulärer Nekrose des proximalen Kahnbeinpols. Beschreibung eines neuartigen Operationsverfahrens.

The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a dreaded complication after conservative or operative treatment of a scaphoid bone fracture, which previously often led to partial or total stiffening operations on the wrist. Vascularized bone grafts can be used to increase the bone fusion rates in the presence of scaphoid pseudarthrosis with avascular necrosis. On a note of caution, it must be mentioned, though, that such a procedure in the presence of avascular necrosis of the proximal pole with destruction of cartilage can lead to premature radiocarpal arthritis, because a friction-free gliding in the area of the proximal scaphoid pole is no longer ensured as a result of the lacking cartilage cover.We confronted these problems in a 20-year-old male patient with avascular necrosis of the proximal scaphoid bone pole and destruction of the corresponding scaphoidal cartilage cover. We transplanted a free vascularized cartilage-bone graft from the medial femoral condyle, which was adapted in form and size to the proximal scaphoid bone pole with corresponding cartilage cover and was connected to the radial vascular bundle. This novel operation technique is described in this report and appears to be a promising way of avoiding premature radiocarpal arthritis when treating scaphoid bone pseudo-arthrosis with avascular necrosis in the presence of cartilage destruction.

A comprehensive test system to identify suitable antibodies against p53 for immunohistochemical analysis of canine tissues.

The tumour suppressor p53 is commonly detected in tissues of companion animals by means of antibodies raised against the human protein. The following three-step procedure was devised to test the suitability of such antibodies for immunohistochemistry on canine tissues. (1) Western blot and immunohistochemical analyses on bacterially expressed recombinant canine protein to assess human-to-canine cross-reactivity. (2) Immunohistochemistry of cultured, UVB-irradiated canine keratinocytes to evaluate suitability for detection of endogenous p53. (3) Immunohistochemistry on tissue arrays to further substantiate suitability of the antibodies on a panel of normal and neoplastic human and canine tissues. Five of six antibodies cross-reacted with recombinant canine p53. Three of these (PAb122, PAb240, CM-1) also immunolabelled stabilized wild type p53 in cell cultures and elicited a consistent, characteristic labelling pattern in a subset of tumours. However, two alternative batches of polyclonal antibody CM-1 failed to detect p53 in cell cultures, while showing a characteristic labelling pattern of a completely different subset of tumours and unspecific labelling of normal tissues. The test system described is well suited to the selection of antibodies for immunohistochemical p53 detection. The results emphasize the need to include appropriate controls, especially for polyclonal antibodies.

[Surgical management of spondylodiscitis. An analysis of 78 cases]. / Die operative Therapie der Spondylodiszitis. Eine Analyse von 78 Patienten.

Spondylodiscitis is a rare bacterial infection of the spine with an inflammatory, destructive course. To obtain further information on the therapeutic management and clinical course of spondylodiscitis, we retrospectively investigated 78 patients after surgical intervention. Mean age was 64 years (+/-4.6 years; range 21-80 years), the mean length of stay 49 days (+/-8.2 days; 3-121 days) including 24 days (+/-4.7 days; 0-112 days) in ICU. In hospital mortality was 9%. The cervical spine was affected in 10%, the thoracic spine in 35% and the lumbar/sacral spine in 55% of patients. Abscess formation occurred in 65% and destruction of the vertebral body in 74%. A total of 75% of patients presented with neurological deficits which could be improved by surgical intervention in 82% of cases. 24 patients were treated by ventral debridement and stabilization alone, 20 patients with a combined dorsoventral method. Most patients (n=34) were stabilized via dorsal bridging instrumentation without ventral debridement of the focus. Of this group, 23 patients were initially scheduled for secondary ventral debridement but complete healing was achieved prior to this, so further surgical therapy was unnecessary. Successful cure was obtained in 92% of cases. Based on our findings, we favor a split surgical approach: initially with dorsal internal fixation only. Abscesses can be drained percutaneously. Ventral debridement and stabilization is only recommended if insufficient stability can be obtained by dorsal fixation alone, as shown by the persistence of infection or pain.

[Avascular necrosis of the capitate in athletes]. / Die avaskuläre Kapitatumnekrose bei Sportlern.

The possibility of osteonecrosis of the carpal bones should always be considered when athletes present with pain of unknown origin in the hand and wrist, in particular, if they are participating in sports such as gymnastics or weight-lifting that involve extreme loading of the wrist with axial compression and microtrauma. This sort of extreme loading of the wrist combined with a constitutionally "weak" blood supply to the individual carpal bones may lead to the formation of osteo-necrotic zones. A treatment method that can produce excellent results, depending on the pathomorphology, is available in the form of vascularized bone grafting.

Role of subtilisin-like convertases in cadherin processing or the conundrum to stall cadherin function by convertase inhibitors in cancer therapy.

Cadherins are a family of intercellular adhesion receptors. Produced as inactive precursors, they become functional adhesion molecules after proteolytic cleavage by subtilisin-like pro-protein convertases (PCs). Owing to their activation and assembly into multiprotein adhesion complexes at sites of cell contacts, adhesion-competent cadherins are prerequisite for tissue integrity. In recent years evidence has accumulated that intercellular junctions not only provide mechanical linkage, but in addition are potent modulators of signalling cascades. This infers a biological role to intercellular adhesion complexes that is significantly more complex and powerful. Currently, the broad implications of disturbances in somatic tissue adhesion components are only just beginning to emerge. Prominent examples of adhesion defects include autoimmune diseases, or tumour invasion and metastasis and malignant transformation. This review reports on our current knowledge of cadherin function and their maturation by pro-protein convertases, and puts special emphasis on the consequences of pro-protein convertase inhibition for epithelial tissue homeostasis.

[Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique]. / Die operative Versorgung suprakondylärer Femurfrakturen bei liegender Knieendoprothese-"less invasive stabilization system" (LISS) oder retrograder Marknagel? Probleme in der Anwendung minimal-invasiver Verfahren.

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.

[Osteomyelitis of the spine]. / Osteomyelitis der Wirbelsäule.

Spinal infections are rare, occurring most often in elderly patients with urinary tract infections or diabetes. With the increasing number of patients with immune suppression, and also the increasing number of immigrants in the population, spinal infections are seen more frequently, especially in young adults. Typically spinal infections are monomicrobial, Staphylococcus aureus being the most common organism. Hematogenous spread of bacteria through the arterial paravertebral collateral vessels into the subchondral bone marrow of the vertebral bodies is the most common source of infection. Clinical presentation is often nonspecific. Important diagnostic measurements are laboratory studies, radiological evaluation including MR image scans, and CT-guided percutaneous biopsy of the lesion for microbiological studies. The management of spinal infections consists of antimicrobial therapy over 6-8 weeks. Surgical intervention is indicated in neurologically compromised patients for spinal instability and abscesses.

[The postoperative control CT after a fracture of the acetabulum. A useful quality control measure or an unnecessary exposure to radiation?]. / Die postoperative Kontroll-CT nach Acetabulumfraktur. Sinnvolle Qualitätskontrolle oder unnötige Strahlenbelastung?

Fractures of the acetabulum are severe injuries of the hip joint. Exact preoperative management is necessary to make possible an anatomical reconstruction. Postoperative quality control is done best with computed tomography. Is the higher radiation exposure caused by this routine examination justified?During the 5 years from 1995 to 1999, a total of 154 patients with fractures of the acetabulum were examined postoperatively at our clinic using CT to control reconstruction, implant position and the remaining free fragments in the joint. Thirteen of these patients (8.4%) had to be re-operated after postoperative CT control. The causes of the re-operation were four cases of an intra-articular implant position, three of free fragments remaining in the joint, and in 6 patients showed inadequate reconstruction. The mean radiation exposure was 25 mGy per patient. The low mean age of the patients and the long lasting consequences of a probably unrecognised complication, justify routine, postoperative CT control, even though the radiation exposure is about 10 mGy higher than the conventional radiological diagnosis. The use of CT diagnosis as a routine postoperative measure is an appropriate control procedure that allows an objective assessment of the quality of the result for the patient as well as for the surgeon.

[10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus]. / 10-Jahres-Ergebnisse knochenmarkstimulierender Therapie der Osteochondrosis dissecans tali.

The optimal operative therapy for the treatment of osteochondritis dissecans tali is still controversial. Beside bone marrow-stimulating techniques like abrasion arthroplasty, drilling and microfracturing, new techniques like autologous osteochondral transplantation and autologous chondrocyte transplantation are increasingly used. This study reviewed the clinical, radiological and subjective long-term outcome of bone marrow-stimulating therapy for 45 ankles with an osteochondritis dissecans tali stage 3 or 4 according to the classification by Berndt and Harty. All ankles were treated by the removal of the dissecate and abrasion of the subchondral bone. In 67%, an additional antegrade drilling of the defect was performed. The average maximum size of the lesion was 1.1 cm. At follow-up examination, 10.4 years (7.1-13.5 years) postoperatively, the average AOFAS-score was 91 points (66-100 points). Using the score of Mazur, the outcome of 28 ankles (62%) was rated excellent, 12 ankles (27%) were rated good and five ankles (11%) fair or poor. Progressive osteoarthritic changes, according to the classification of van Dijk, were seen in seven ankles (16%). Reoperations were necessary in eight cases (18%). Obesity, age older than 40 years and preoperative osteoarthritic changes had a significant negative impact on the clinical outcome. Bone marrow stimulating therapy is an inexpensive, low invasive therapy and a good therapeutic option at least for small Berndt/Harty stage 3 and 4 ODT lesions. Autologous chondrocyte transplantation and osteochondral autografts yield encouraging 2- and 4-year results, but still have to prove their superiority in long-term follow-up studies.

[Importance of the cross-sectional area of the spinal canal in thoracolumbar and lumbar fractures. Is there any correlation between the degree of stenosis and neurological deficit?]. / Die Bedeutung des Wirbelkanaldurchmessers im thorakolumbalen und lumbalen Bereich nach Trauma. Korreliert der Grad der Einengung mit dem neurologischen Defizit?

A relationship between traumatic spinal canal stenosis and the degree of neurological deficit is known for the cervical spine. However, this has not been proven for the thoracolumbar and lumbar spine. During a period of 4 years, from 1996 to 1999, 1168 patients with a spinal injury were treated at our department, 473 of these by operation. Thirty-five were examined in a separate group. They showed a single fracture of the thoracolumbar and lumbar spine with stenosis of the spinal canal. All fractures were single burst fractures after blunt trauma. All patients were conscious and fully oriented at the time of admission and a thorough neurological examination could be performed. The fractures were diagnosed by conventional X-ray in two views and computed tomography (CT). Using the transverse CT scans in horizontal view, the sagittal diameter was measured and the degree of stenosis calculated in percent at the level of the fracture and one below and above. The group included 25 male and 10 female patients, with a mean age of 38 years (range: 17-61 years). Of the 35 patients, 19 (54.3%) showed neurological deficits after spinal cord injury,and 16 (45.7%) were without any neurological complications at the time of first admission to the hospital. There was no correlation between the extent of spinal canal stenosis and the degree of the neurological deficit. One patient with stenosis of 20% suffered from neurological dysfunction, others with stenosis up to 80% were without spinal cord injury. The average stenosis of the spinal canal was 49.6% in cases with cord injury and 46.3% in patients without neurological dysfunction. No correlation and no predisposing anatomical structures could be found between stenosis and neurological deficit.

Arthrodesis of the shoulder after septic arthritis. Long-term results.

We analysed the long-term results of arthrodesis of the shoulder after infection in 15 patients. At the time of operation, 14 cultures were positive for Staphylococcus aureus. The mean follow-up was 8.3 years (3 to 14) and 90% of the patients were satisfied with the outcome. There were complications in five patients (33%); in three there was nonunion with loosening of the implant. One patient had a sound bony union but with a persistent sinus six years after arthrodesis and another had a sinus which healed after the metal was removed. Four of these five patients (80%) were heavy smokers (> 20 cigarettes/day). Cancellous bone grafting did not affect the incidence of complications. The mean age of the patients with complications was 58.6 v 48.6 years for those without (p = 0.2808; not significant). Those with complications had had more previous operations (6.4 v 2.5, p < 0.05). Antibiotics, as determined by the bacteriological cultures, were administered for six weeks. The complication rate was higher in patients with active sepsis but the younger the patient and the fewer number of previous operations (< 50 years, < four previous operations), the better was the outcome. Considering the rate of complications, we recommend early surgery in these patients.